This protocol covers first-line management of symptomatic hallux valgus presenting with pain at the first metatarsophalangeal (MTP) joint, where the hallux valgus angle is 20° or greater, or the first intermetatarsal angle is 14° or greater. Patients typically describe a gradual onset of sharp pain at the MTP joint that is worse on weight bearing.
The hallux valgus angle and intermetatarsal angle (IMA) are used to sub-classify deformity severity. This protocol applies when at least one of the angle criteria is met: hallux valgus angle ≥ 20° or first intermetatarsal angle ≥ 14°. Forefoot pain at the first MTP joint on weight bearing is the primary symptom.
Initial management focuses on conservative measures — including pain control, footwear assessment and modification, and offloading of the first MTP joint. Physiotherapy targeting balance, proprioception, and core stability may also be part of the approach. For certain patients, a further intervention directed at the joint itself may be considered under specific indications. The complete sequencing, full list of options, and decision criteria are in the full regimen below.
Goals: Resolution of forefoot pain at the first MTP joint and improved foot function.